Anatomical liver resection was an option for liver cancer proposed by the Japanese scholar Masatoshi Makuuchi in 1985 [1].Reich et al.performed the first laparoscopic liver resection in1991 [2].The safety and effectiveness of laparoscopic anatomical liver resection had been verified in recent years [2-4].However,laparoscopic anatomical segmentⅦliver resection （LAS7） was the most difficult procedure because of complex adjacent structures,difficult exposure,and limited laparoscopic view [3,5].

e15153 Background: Hepatic sarcomatoid carcinoma (HSC) is a rare and highly malignant tumor, which accounts for less than 2% of hepatic carcinoma. HSC can occur in the liver (Sarcomatoid hepatocellular carcinoma, SHCC) or in the intrahepatic bile duct (Sarcomatoid intrahepatic cholangiocarcinoma, SiCCA). We aimed to compare the clinical characteristics and genomic features between SHCC and SiCCA. Methods: In this study, we recruited 20 patients who were pathologically diagnosed with HSC from January 2018 to February 2021 in Hunan Provincial People’s Hospital. Whole exome sequencing and PD-L1 expression detected by immunohistochemistry were performed on the qualified tissue samples obtained from18 (14 with SHCC and 4 with SiCCA) of the enrolled patients. Tests were performed in OrigiMed, a College of American Pathologists (CAP) accredited and Clinical Laboratory Improvement Amendments (CLIA) certified laboratory. Fisher test was used to determine the association between two categorical variables, and P< 0.05 was considered statistically significant. Results: A total of 15 cases of SHCC and 5 cases of SiCCA were enrolled in this study, with median age of 59 years old (ranged from 34 to 75 years old). Among them, 15 (75%) were diagnosed as AJCC stage III-IV. Compared with SiCCA, we observed a significant higher proportion of undifferentiated samples in SHCC ( P< 0.001) (Table 1). The most commonly mutated genes of HSC included TP53 (64% in SHCC and 75% in SiCCA) and TTN (43% in SHCC and 100% in SiCCA). The most commonly mutated genes in SHCC also included TERT (43%), CCDC168 (36%), and LATS1 (36%), and that in SiCCA also included CDKN2A (50%), KRAS (50%), and CDKN2B (50%). All these genes were mainly enriched in cell cycle and ERBB pathway. In addition, amplifications of HYDIN, C4A, LRRC37A and deletions of CDKN2A, NTRK2, NTRK3, NRG1, PAX3, OR4K5, TPP2 and KRTAP4-6 were detected in the SHCC cohort, and amplifications of ZDHHC11, PMS2 and deletions of NRG1 and CDKN2A were detected in the SiCCA cohort. We also assessed TMB and PD-L1 status among these two cohorts. We found that 86% (12/14) of SHCC and 100% (4/4) of SiCCA had TMB of lower than 10 mutations/Mb. The expression of PD-L1 was positive (CPS > = 1) in 86% (12/14) of SHCC and 75% (3/4) of SiCCA. Conclusions: We are the first to discover the significant differences in tumor differentiation between SHCC and SiCCA. We also profiled the mutational characteristics, TMB status, and PD-L1 status of HSC, shedding light on the precision medicine of HSC. [Table: see text]

良好的术野暴露和操作空间是完成腹腔镜肝切除手术的基础，对于肝Ⅶ段肿瘤的切除，腹腔镜手术存在较大困难和风险。本研究回顾性分析7例完全腹腔镜下肝蒂优先背侧入路解剖性肝Ⅶ段切除患者的临床资料。术后病理结果提示肝细胞癌3例、肝局灶性结节增生2例、肝血管平滑肌脂肪瘤1例、神经内分泌癌1例，7例患者术后均未出现Clavien-Dindo Ⅲa级以上并发症。术后住院5~14（8.5±2.4）d。至随访截止日期，所有患者均存活，4例恶性肿瘤患者术后未见明显复发征象。本研究表明由熟练的手术团队施行肝蒂优先背侧入路腹腔镜解剖性肝Ⅶ段切除安全可行，近期疗效优良。

患者男，48岁，因“左上腹疼痛3周，伴小便黄染1周”入院。查体：腹膨隆，左上腹压痛、反跳痛，肝、脾区叩痛，移动性浊音阳性；家族史：叔叔因“肝病”去世。腹部CT（图1）：肝内呈弥漫性雪花样改变提示肝脏、脾脏弥漫性病变，考虑遗传性出血性毛细血管扩张症（hereditary hemorrhagic telangiectasia，HHT）并动静脉瘘；脾脏较大肿块合并出血，考虑血管瘤。Hb 66 g/L，急诊全麻行脾切除、肝组织活检术，术中盆腹腔内约3 000 ml暗红色积血，肝脏呈肝硬化改变，表面可见多发小血管瘤样改变，脾脏下极见大小15 cm× 12 cm× 10 cm肿瘤，膈肌面破裂出血。术后病理：（1）脾脏血管内皮瘤（图2A）；（2）肝组织镜下肝实质内灶状小血管扩张呈海绵状血管瘤样改变（图2B）。免疫组化：脾脏肿瘤：CD34、CD31、ERG均为阳性；肝组织活检：CD34（图2C）、CD31阳性、Hepatocyte阴性。术后复查肝功能损伤进行性加重。术后腹部CT（图3）示肝脏弥漫性病变增加。术后第4天患者出现肾功能不全，呼吸衰竭，肺动脉高压，心肺功能不全，脓毒血症。患者拒绝行肝移植手术，家属要求转回当地医院治疗，出院后一周随访患者已死亡。

患者,女,53岁,因"体检发现左肾占位1周"入院,无腰部疼痛、肉眼血尿等症状.彩超示左肾实质低回声包块,边界欠清,大小约4.9 cm×3.5 cm;CT(图1、2)示左肾下极见一密度不均的团块状软组织样密度影,体积约5.2 cm×3.8 cm×3.4 cm.全麻下行腹腔镜左肾部分切除术.

患者男，21岁。无明显诱因感上腹部疼痛伴腹胀1个月余，停止排气排便5 d。以“肠梗阻”收入院，腹部CT示肠套叠（回肠-回肠型）并低位小肠梗阻，剖腹探查术中见一隆起型肿物位于回肠内，活动性较差，行肠套叠复位肠切除吻合手术。镜下观察：肿瘤细胞弥漫分布，瘤细胞明显异型，呈梭形、卵圆形，核大深染，部分区域呈条束状排列，核仁明显，核分裂象易见，可见病理性核分裂象，瘤组织大部分区域呈多形性未分化肉瘤形态，其中局灶可见瘤细胞直接成骨。免疫组织化学检测结果示SATB2、p16、波形蛋白均为弥漫阳性，其中局灶结蛋白、Myogenin、MyoD1阳性。诊断为小肠转移性成纤维型骨肉瘤伴局灶横纹肌肉瘤成分。.

患者男性,65岁,既往无腱鞘巨细胞瘤病史及外伤手术史.现左肘关节进行性增大的包块,左肘、左腕关节活动受限,并伴有不可耐受的持续性胀痛,已半年.实验室检查:血常规、血沉、CRP、降钙素原、多肿瘤标志物未见明显异常.MRI平扫及增强(图1)提示左侧肘关节内侧旁见3.9 cm×6.0 cm×6.0 cm软组织肿块,考虑腱鞘巨细胞瘤.患者行左肘关节肿瘤切除术,术中见一类圆形肿物,质硬,并侵犯肱骨内髁,伴出血坏死.

自噬是细胞清除胞质中受损、缺陷或无用的细胞器、长寿命蛋白质和脂质,并回收其成分以满足生物新陈代谢的营养和能量需要的主要分解代谢过程.急性胰腺炎(AP)是常见I临床急症,其发病率也逐年升高.研究显示,自噬在AP的发病过程中起到重要作用,可以导致胰腺腺泡细胞内胰蛋白酶原的激活,腺泡细胞内大液泡积聚,诱发促炎介质的释放,引起胰腺炎症细胞浸润和全身性炎症反应.笔者就自噬的分子机制以及自噬在AP发生、发展中作用机制的研究进展进行综述.